Category: May 2017

I’ve moved to the other side. But the thing is, it’s not so dark where I stand.

During my residency in medical oncology, amidst the strain of learning my craft, seeing countless appointments, and studying for board exams, I centered myself by meditating on where I would wind up working when I finished. It would be my first professional job and I envisaged seemingly infinite considerations to ponder – location, benefits, hours, size of facility, caseload, etc. Sitting atop the algorithm for my decision was the question: Did I want to work in private practice or academia?

As I approached the terminal days of my residency in 2009, the economy was shifting and the proportion of opportunities for employment were a mere fraction of what is available nowadays. Candidates nowadays have their pick among dozens of opportunities, whereas I applied for the grand sum of three jobs. Two were in private practice, while the third was an academic position at a veterinary school.

Each had the requisite pros and cons and I dutifully weighed my options. Would geography be the deciding factor or would it come down to the numbers? Where would I feel the most valued and useful and professionally satisfied? To fully consider those questions I had to take a serious look at what brought me to this decisive point in the first place.

Despite wanting to be a veterinarian since I first knew there was such a thing as an “animal doctor”, I took a rather circuitous route to veterinary school and becoming a medical oncologist. I was studious during high school and undergraduate, but my sub-stellar GPA wasn’t going to garner an acceptance, and as I approached graduation, I recognized I concurrently lacked the motivation and maturity necessary for admission at that particular time in my life.
I embarked on a Master’s degree to buy myself some time to cultivate personal needs before committing to such a specific career pathway. To help finance my advanced education, I was offered an instructor position teaching anatomy and physiology to non-Biology majors. A decision made out of a financial necessity morphed into an awakening of a passion for educating others, especially those who lacked the same enthusiasm I possessed about science and the intricacies of the form and function of the human body.

A few months into my post-graduate degree, I decided to switch gears and pursue my PhD in biology. My goal was to obtain the appropriate credentials necessary to be employed at a small, liberal arts college, teaching, and maybe think of vet school one day, when I was old. Like, you know, 35 or so…

I quickly learned the majority of individuals who pursue PhD degrees in biological sciences rarely do so for the primary want to teach. My ambitions landed as square pegs amongst the round holes of my colleagues, who were vastly more dedicated to basic science research than I was. Without much deliberation, I decided to hasten my timeline and applied for veterinary school sooner than my initial thoughts of “many years into the future”. Fortunately, I was accepted, and approximately 8 years later, found myself repeating the process of deliberating another major life decision related to my professional career. While jumping through the last hoops of my residency I struggled over deciding which job among the three I applied for would be the “perfect” one for me. Though I agonized over miniscule details, my heart and head agreed that teaching was the place for me and the academic job was what I wanted. I never considered the possibility that the choice wouldn’t be mine.

I wasn’t offered the job in academia. While not the first time I didn’t get what I wanted out of life, it was the only time I’d targeted a professional goal and failed to obtain it. My disappointment was magnified when my top choice of the two private practice jobs passed me over as well.

Four years of undergraduate work, a Master’s degree, two years of a PhD, four years of veterinary school, one year of internship, and three years of residency did not provide me with the promised chance to “be anything I want to be.” Instead, I was left working at the only job I was offered.

At no point in my lengthy training did I consider I that I would not wind up happy professionally. I knew I would face day-to-day annoyances and understood there would be expectations beyond my capabilities. I wasn’t expecting rainbows and unicorns, but I never thought I would harbor a persistent and progressive sense of frustration and restlessness in my career.

With each passing year of working in private practice, I grew increasingly impatient and discouraged with myself professionally. I changed positions and geographic venues several times over the span of nine years, but never found a place where I felt content with my contribution to my occupation. I was burdened by the relentless nagging concern of, “What if?”

What if I had been chosen for the academic job several years ago? What if I was responsible for teaching veterinary students how to be better doctors? What if I had the chance to start engaging in research again? Would that world sustain me greater intellectually? Would I feel more productive or contributory towards my chosen field? Would I even be good at it?
Then there are the more abstract questions: What if I was chosen for the academic position years ago? Would I still have met my husband and be married? Would I have liked living there? Would I always wonder what life in private practice was like?
While contemplating the parallel, but alternative, world my life could have taken was interesting and intellectually stimulating, it didn’t help me understand what the best approach to changing my current situation. I remained stagnant and unfulfilled.

About a year ago, an opportunity arose for an academic position for a medical oncologist at North Carolina State University’s teaching hospital. I mentioned it to my husband, more in passing than with any edge of seriousness. When he encouraged me to send in my CV, I listed innumerable reasons why I shouldn’t.

Despite the myriad of reservations I put forth, he provided the one and only one that mattered. He was the only other person who knew I’d always wondered, “What if?” His persuasion pushed me to apply for the job as I’d already talked myself out doing so.

I was stunned when the call came through offering me the position. Once the initial euphoria wore off a little, I immediately questioned if this was the right choice, time, move, or place for me. Self-doubt crept up and reminded me I wasn’t good enough for academia back when I finished my residency, so why would I be a better candidate now?

How could I leave my current job and new house? Why would I want to disappoint my friends and family with yet another move and yet another story about how this will be the right job for me. There were many reasons not to take the offer, which were outweighed by the most important reason why I had to do it: it truly was what I always wanted to do. I knew it was time to stop wondering, “What if?”

While I have only been here at NC State a few short months, I cannot stress how much this was the right choice for me. I have trouble connecting with that person who so deeply resisted making this change. I am happy professionally and living in a place I’ve already grown to think of as my home.

Some say the other side has greener grass, while others say it’s darker. The truth is, you’ll never know until you take the leap of faith over the fence to see what it’s really like.

Like this:

Lymphoma is a blood-borne cancer of lymphocytes, which are a specific type of white blood cell. It is the most common cancer diagnosed in dogs. There are several forms of lymphoma in dogs, the most common being high-grade lymphoblastic B-cell lymphoma, which closely resembles non-Hodgkin’s lymphoma in people. Lymphoma is one of the most treatable cancers in dogs, and recent developments in targeted therapies, monoclonal antibodies, and bone marrow transplantation could offer the hope of a cure in the future. Whether your dog was recently diagnosed, currently undergoing treatment, or you’re looking for information about disease prevention, you will find the following tips for treating and beating canine lymphoma valuable.

1. Pet your pup!

While you might expect a dog with cancer to show signs of illness, many dogs with lymphoma behave normally. Feeling enlarged lymph nodes may be the only sign something is wrong, and early detection is helpful for ensuring your dog is a good candidate for treatment. Lymph nodes are most readably felt under your dog’s chin, in front of his or her shoulders, and behind the knees. If you’re not sure about where to feel, here is a helpful video showing the location of lymph nodes in dogs. Don’t be afraid to ask your veterinarian for help. If you feel anything suspicious, contact your veterinarian so your dog can be evaluated as soon as possible.

2. Ask your vet for a referral to a board-certified oncologist.

If your primary physician was suspicious you had cancer, they would refer you to an oncologist. The same is true for your dog. Meeting with a veterinary oncologist does not mean you are committing to a specific treatment plan. Rather, this is your opportunity to ask questions about what to expect if your pet were to be treated for his disease versus if he were not, and to talk about what tests could be valuable for learning more about your dog’s cancer. Veterinary oncologists have extensive experience in the diagnosis and treatment of canine lymphoma. They will provide the most up-to-date information and have access to advanced treatment options beyond what is available to a general practitioner. For example, there is a newly approved drug for treating lymphoma in dogs that is currently only available to oncologists and could be an excellent option for your pet.

3. Purchase pet insurance.

While this is not an option to help pay for treatment following a diagnosis, many pet insurance companies will reimburse owners for a portion of the cost of cancer treatment for dogs insured prior to being diagnosed with cancer. Diagnostic tests and cancer treatment costs vary, but typically range from several hundred to several thousand dollars. Owners frequently admit discomfort with the impact that cost has on their decision to pursue treatment. Insurance can relieve some of this burden, allowing them to pursue options they would not have had without coverage. Some pet insurance companies offer “cancer riders” that provide additional reimbursement specifically for cancer care.

Prednisone is frequently prescribed to dogs with lymphoma at the time of diagnosis, prior to consultation with a veterinary oncologist. Prednisone is a potent anti-inflammatory drug and can also help kill off a certain proportion of cancerous lymphocytes. While this may seem like a good thing to happen while you’re waiting for your referral appointment, there are two main concerns with this approach. One is prednisone administration prior to pursuing definitive treatment could interfere with tests your veterinary oncologist may recommend. Testing routinely includes labwork to look for cancerous lymphocytes in circulation, as well as imaging tests such as X-rays and abdominal ultrasound exams. If prednisone is started prior to executing these tests, the changes consistent with disease may improve or even completely resolve and your oncologist won’t be able to interpret the data correctly. This means they won’t be able to tell you an accurate stage of your pet’s disease.

Secondly, it is speculated that steroids can induce resistance to certain chemotherapy drugs used to treat lymphoma. This means dogs receiving steroids before chemotherapy could have less chance of responding to treatment, and their duration of response could be shorter.

Exceptions to this tip include dogs who are sick from lymphoma (e.g. not eating or having trouble breathing) and require more immediate treatment.

5. Don’t start your dog on any supplements, vitamins, nutraceuticals, or diet changes until you speak with your veterinarian.

It’s human nature to use the Internet to gather information about your pet’s health. A quick search for “canine lymphoma” returns nearly 500,000 hits. An impressive subset of this information is dedicated to the concept of treating dogs with lymphoma with homeopathy or other “natural” substances. Most sites lack evidence-based information proving such data is accurate. The rationale of “it may not help, but it can’t hurt” is false. The absence of a negative side effect does not imply safety—this is what FDA regulation is all about.

Some supplements could potentially negatively interfere with chemotherapy. For example, antioxidants may interfere with the mechanism of action of certain chemotherapy drugs as well as the normal physiologic way tumor cells are broken down by the body. There’s also evidence antioxidants may promote cancer growth. This doesn’t mean antioxidants don’t possess potential benefits, it simply reinforces that they must be used rationally and with appropriate research evidence to support their use.

While there are no known ways to prevent lymphoma in dogs, we do see this cancer in certain breeds more frequently (Golden Retriever, Labrador Retriever, Boxer, Bull Mastiff, Basset Hound, St. Bernard, Scottish Terrier, Airedale, and Bulldog). Owners of these breeds should talk with their veterinarian about what monitoring steps could be useful. Individuals considering owning one of the at-risk breeds should inquire with their breeder (if possible) about any known cancer patterns in their lines.